0
March 7, 1986, Vol 255, No. 9 >
ARTICLE | March 7, 1986

Intensive Care Units, Scarce Resources, and Conflicting Principles of Justice FREE

H. Tristram Engelhardt, Jr, PhD, MD; Michael A. Rie, MD
[+] Author Affiliations

Reprint requests to Department of Anesthesia, Massachusetts General Hospital, Boston, MA 02114 (Dr Rie).


JAMA. 1986;255(9):1159-1164. doi:10.1001/jama.1986.03370090081025
Text Size: A A A
Published online
Article
References

HUMANS often have the aspirations of deities, though never the resources. Intensive care units (ICUs) provide an example of the desire to provide an optimal level of care for all who require it, where "optimal" is taken to mean the highest achievable standard of care. However, recent budgetary retrenchments in the provision of funds for health care show that health care is not always an overriding public policy priority. Consequently, as a matter of morality and public policy, it will be necessary to determine at what point undesirable standards of health care are simply unfortunate, but not unfair in the sense of constituting a claim on further resources.

We explore the distribution of health care resources by addressing the problem of allocating ICU beds (1) when further admissions to an ICU will jeopardize the standard of health care for all those in the ICU, (2) when those eligible for admission

REFERENCES

1 +
Engelhardt HT Jr:  Shattuck Lecture—Allocation of scarce medical resources and the availability of organ transplantation: Some moral presuppositions . N Engl J Med 1984;;311:66-71.
2 +
Rawls J: A Theory of Justice . Cambridge, Mass, Belknap Press, 1971;.
3 +
Nozick R: Anarchy, State, and Utopia . New York, Basic Books Inc Publishers, 1974;.
4 +
Engelhardt HT Jr:  Health care allocations: Responses to the unjust, the unfortunate, and the undesirable , in Shelp EE (ed): Justice and Health Care . Dordrecht, the Netherlands, D Reidel Publishing Co, 1981;, pp 121-137.
5 +
Brody B:  Health care for the haves and have-nots: Toward a just basis of distribution , in Shelp EE (ed): Justice and Health Care . Dordrecht, the Netherlands, D Reidel Publishing Co, 1981;, pp 151-159.
6 +
Engelhardt HT Jr: The Foundations of Bioethics . New York, Oxford University Press, 1985;.
7 +
Securing Access to Health Care . President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavior Research. 1983;, p 42.
8 +
Russel LB:  The role of technology assessment in cost control , in McNeil BJ, Cravalho EG (eds): Critical Issues in Medical Technology . Boston, Auburn House, 1982;, pp 129-138.
9 +
Intensive Care Units (ICUs): Clinical Outcomes, Cost and Decision Making; Health Technology Case Study 28 . Office of Technology Assessment, 1984;.
10 +
Von Stetina v Florida Medical Center, 2 Fla Supp 2d 55 (Fla 17th Cir 1982), 436 So Rptr 2d 1022 (1983), 10 Florida Law Weekly 286 (Fla May 24, 1985).
11 +
Calabresi G:  Reflection on medical experimentation in humans , in Freund PA (ed): Experimentation in Human Subjects . New York, George Braziller Publishers, 1969;, pp 178-196.
12 +
Scheffler RM, Knaus WA, Wagner DP, et al:  Severity of illness and the relationship between intensive care and survival . Am J Public Health 1982;;72:449-460.
13 +
Knaus WA, Draper EA, Wagner DP:  The use of intensive care: New research initiatives and their implications for national health policy . Milbank Mem Fund Q 1983;;61:561-583.
14 +
Knaus WA, Zimmerman JE, Wagner DP, et al:  APACHE—acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;;9:591-597.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Engelhardt HT Jr:  Shattuck Lecture—Allocation of scarce medical resources and the availability of organ transplantation: Some moral presuppositions . N Engl J Med 1984;;311:66-71.
2 +
Rawls J: A Theory of Justice . Cambridge, Mass, Belknap Press, 1971;.
3 +
Nozick R: Anarchy, State, and Utopia . New York, Basic Books Inc Publishers, 1974;.
4 +
Engelhardt HT Jr:  Health care allocations: Responses to the unjust, the unfortunate, and the undesirable , in Shelp EE (ed): Justice and Health Care . Dordrecht, the Netherlands, D Reidel Publishing Co, 1981;, pp 121-137.
5 +
Brody B:  Health care for the haves and have-nots: Toward a just basis of distribution , in Shelp EE (ed): Justice and Health Care . Dordrecht, the Netherlands, D Reidel Publishing Co, 1981;, pp 151-159.
6 +
Engelhardt HT Jr: The Foundations of Bioethics . New York, Oxford University Press, 1985;.
7 +
Securing Access to Health Care . President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavior Research. 1983;, p 42.
8 +
Russel LB:  The role of technology assessment in cost control , in McNeil BJ, Cravalho EG (eds): Critical Issues in Medical Technology . Boston, Auburn House, 1982;, pp 129-138.
9 +
Intensive Care Units (ICUs): Clinical Outcomes, Cost and Decision Making; Health Technology Case Study 28 . Office of Technology Assessment, 1984;.
10 +
Von Stetina v Florida Medical Center, 2 Fla Supp 2d 55 (Fla 17th Cir 1982), 436 So Rptr 2d 1022 (1983), 10 Florida Law Weekly 286 (Fla May 24, 1985).
11 +
Calabresi G:  Reflection on medical experimentation in humans , in Freund PA (ed): Experimentation in Human Subjects . New York, George Braziller Publishers, 1969;, pp 178-196.
12 +
Scheffler RM, Knaus WA, Wagner DP, et al:  Severity of illness and the relationship between intensive care and survival . Am J Public Health 1982;;72:449-460.
13 +
Knaus WA, Draper EA, Wagner DP:  The use of intensive care: New research initiatives and their implications for national health policy . Milbank Mem Fund Q 1983;;61:561-583.
14 +
Knaus WA, Zimmerman JE, Wagner DP, et al:  APACHE—acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;;9:591-597.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems